title: Crescentic glomerulonephritis associated with vascular endothelial growth factor (VEGF) inhibitor and bisphosphonate administration.
abstract: Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, has been widely used in a variety of malignancies offering substantial clinical benefit. Hypertension and proteinuria are the most commonly reported manifestations of bevacizumab-related nephrotoxicity with the risk increasing along with the dose and with the concomitant use of bisphosphonates. We describe the first case of a patient with small-cell lung cancer who developed diffuse extracapillary necrotizing crescentic glomerulonephritis, temporarily necessitating haemodialysis, following administration of bevacizumab and zolendronate. Renal function improved without any specific treatment and the patient remained off dialysis after withdrawal of bevacizumab-zolendronate. Special caution is required when VEGF inhibitors are combined with bisphosphonates. Such a combination can cause crescentic necrotizing glomerular lesions. Withdrawal of the offending medications may be adequate for the alleviation of this severe glomerulonephritis.
authors.affiliation: Department of Nephrology, Heraklion University Hospital, Crete, Greece. kstylianu@gmail.com
authors.forename: Kostas
authors.initials: K
authors.lastname: Stylianou
authors.forename: Eirini
authors.initials: E
authors.lastname: Lioudaki
authors.forename: Elisavet
authors.initials: E
authors.lastname: Papadimitraki
authors.forename: George
authors.initials: G
authors.lastname: Kokologiannakis
authors.forename: Nikos
authors.initials: N
authors.lastname: Kroustalakis
authors.forename: Christina
authors.initials: C
authors.lastname: Liotsi
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Giannakakis
authors.forename: Vasilios
authors.initials: V
authors.lastname: Georgoulias
authors.forename: Eugenios
authors.initials: E
authors.lastname: Daphnis
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005921:Glomerulonephritis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy*; D008297:Male; D006435:Renal Dialysis; D055752:Small Cell Lung Carcinoma / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D000077211:Zoledronic Acid
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000077211:Zoledronic Acid